Objective: To investigate the effect of nutritional status grading intervention combined with multimodal supervised exercise training in elderly patients with ischemic stroke and frailty. Methods: 92 elderly patients with ischemic stroke and frailty were enrolled and divided into a control group and a combination group according to different intervention methods, with 46 patients in each group. The control group received routine nursing intervention, while the combination group received nutritional status grading intervention combined with multimodal supervised exercise training. The intervention lasted for 8 weeks. Frailty degree, nutritional status, kinesiophobia, and motor function were compared between the two groups of patients. Results: After 8 weeks of intervention, the physical, psychological, social dimension scores, and the total score of the Tilburg Frailty Indicator (TFI) in the combination group were lower than those in the control group (P<0.05). The levels of serum albumin (Alb), prealbumin (PA), hemoglobin (Hb), and transferrin (TF) in the combination group were higher than those in the control group (P<0.05). The scores for the kinesiophobia, activity avoidance, functional disorder, and risk perception dimensions of the Chinese version of the Tampa Scale for Kinesiophobia (TSK) in the combination group were lower than those in the control group (P<0.05). The Berg Balance Scale (BBS) score and the number of 30-second sit-to-stand test (CST) repetitions of both groups of patients were higher than before intervention (P<0.05), and the combination group was higher than the control group (P<0.05). The Timed Up and Go Test (TUGT) completion time was shorter than before intervention (P<0.05), and the combination group was shorter than the control group (P<0.05). Conclusion: Nutritional status grading intervention combined with multimodal supervised exercise training is beneficial for improving frailty and nutritional status in elderly patients with ischemic stroke and frailty, while also effectively alleviating their kinesiophobia and enhancing motor function.